Focus Group Quotes and their Relationship to Study Themes and the Consolidated Framework of Implementation Research Constructs

Quotes

CFIR Constructs

Clinic perspective

Benefits

Saves time

“Yeah, it does [save time]. You know, you call them back, they hand you their blood pressure slip, all you have to do is weight, height… . Just by that piece of paper, it saves quite a bit of time with blood pressure and pulse.” (MA, month 8)

Intervention characteristics (relative advantage)

Provider awareness

“I am much more likely to notice a little slip of paper laying on the top of the counter top than the one that's in the vital signs on the chart.” (Provider, month 8)

Intervention characteristics (relative advantage)

Patient awareness

“It is real positive that the patients now are thinking about their BP as they're seeing the numbers. In the past, they never really saw the numbers so it was something that was told to them which may or may not have been received.” (Provider, month 8)

Intervention characteristics (relative advantage)

Challenges

Perceptions of accuracy

Clinic leaders addressed the initial accuracy concern by asking providers and staff to compare average BPs taken by the kiosks with those taken by MAs. When asked about the comparison experience, one MA responded: “Most of the ones that I've had to re-check are pretty close, within 5 points of that.” (MA, month 2)

Inner setting (implementation climate: compatibility)

“The main problem I think is it's off quite a bit and so then I get questioned so I have to retake it in the room or if I notice it's high, I will always recheck it. About 90% of the time, I recheck it” (MA, month 2).

Characteristics of individuals (knowledge and beliefs about the intervention)

Workflow

“[Whether the kiosk saves time] just depends on how many [patients] you have in a day that either won't use it, don't like it, want it rechecked. Then, it takes more time than if you were just checking it yourself.” (MA, month 8)

Characteristics of individuals (knowledge and beliefs about the intervention)

Job security

“It could be like the airport, … they just walk in the door and you go over to the kiosk.” (Receptionist, month 2, commenting about job security concern)

Inner setting (implementation climate: compatibility)

Patient perspective

Benefits

Patient comfort

“Some patients now have had enough experience with it where they'll just go straight to it, and they know.” (Receptionist, month 8)

Characteristics of individuals (self-efficacy)

More self-service

“Instead of doing nurse visits, [patients] just come, check it, give it to [the receptionists] and they write their name on it and then they bring it back to us, or some leave it on the counter … .” (MA, month 2).

Intervention characteristics (adaptability)

“If they come in with their blood pressure machine and they say, ‘I need to check my blood pressure, check it [using the kiosk] against my own,’ I say go right ahead.” (Receptionist, month 8)

Intervention characteristics (adaptability)

Challenges

Resting before BP measurement

“I think that we would get better readings if the kiosks were located in a different spot, not in the waiting room. If the patient had a chance to sit for a few minutes before they took their blood pressure, be all done with Phreesia pad so that it was not causing them anxiety.” (Provider, month 8)

Characteristics of individuals (knowledge and beliefs about the intervention)

Prehypertension

“It's [the prehypertension notation] an opportunity to enhance some discussion between us and the patient on what that means and what steps they can take.” (Provider, month 2)

Inner setting (implementation climate: relative priority)

“It's not that we don't believe that their blood pressure should be better, it's just we have so much competing for our time.” (Provider, month 8).

Inner setting (implementation climate: relative priority)

Preferred not to use

“We do have people that refuse to use it, because of so many people, bacteria, germs.” (MA, month 2).

Characteristics of individuals (knowledge and beliefs about the intervention)

“A lot of them [patients] just want to stand up there and talk… . Before, you know, while we were checking them in, we could talk to them, but now we just tell them, you got to go do this and, I think it's kind of taken away their social hour.” (Receptionist, month 2).

Characteristics of individuals (knowledge and beliefs about the intervention)